Pedicle Screws & Cement Augmentation

Question:

Pedicle screw with cement augmentation—Is there a separate code for this, or is it included in the instrumentation codes (e.g., 22840, 22842)?

Answer:

Great question, and one that comes up often. Cement augmentation of pedicle screws is considered integral to the instrumentation procedure. There is no separate code for the cement augmentation; it is included in the instrumentation code reported.

Thank you for reaching out to KZA!

*This response is based on the best information available as of 09/17/26.

Newborn Duodenoduodenostomy without Resection

Question:

The provider repairs a duodenal atresia in a newborn with a Diamond duodenoduodenostomy. Which CPT is more appropriate to bill for 44126-52 (for no resection done) or 44130-63 (Pt under 4 kg)?

Answer:

CPT guidelines advise us to “select the CPT code of the procedure or service that accurately identifies the procedure or service performed.” Because there is a CPT code that accurately captures the work performed without the use of the reduced services modifier, CPT 44130 would be the appropriate code to report the duodenoduodenostomy. Modifier 63 would be appended if the infant is less than 4 kg.

*This response is based on the best information available as of 09/17/26.

Modifiers: 58, 78, 79

Question:

Can KZA please explain global modifiers (58, 78, 79)?

Answer:

Excellent question. Modifiers 58, 78, and 79 are used when a patient is in a global period following a prior procedure. Each modifier signals a specific circumstance to the payer, impacting reimbursement and compliance. Here’s how they differ:

Modifier 58 - Staged or Related Procedure

• Used when:

  • Planned or anticipated (staged);

  • More extensive than the original procedure; or

  • Therapy is provided following a surgical procedure.

• Key Points:

  • Resets global period.

  • No payment reduction.

• Example: Definitive fracture treatment following debridement of an open fracture the day prior.

  • Modifier 58 is appended to the ORIF code (XXXXX-58) – This modifier reflects that this procedure is both more extensive and planned.

• Takeaway: The procedure is more extensive, planned, or anticipated.

Modifier 78 - Unplanned Return to the Operating/Procedure Room

• Used when:

  • The patient returns to the OR for an unplanned procedure related to the initial surgery.

• Key Points:

  • No change to the global period.

  • Payment reduction.

• Example: Patient returns to the OR for excision and closure of extensive wound dehiscence.

  • Modifier 78 is appended to code (13160-78) – This modifier reflects an unplanned return to the OR to treat the wound complication associated with the initial surgery.

• Takeaway: The procedure performed involves an unexpected return to the OR for a related procedure – typically a complication.

Modifier 79 - Unrelated Procedure or Service

• Used when:

  • Unrelated Procedure or Service.

• Key Points:

  • Resets global period.

  • No payment reduction.

• Example: Left CTR performed a month after Right CTR.

  • Modifier 79 is appended to code for left (64721-79-LT) – This modifier reflects that this procedure is unrelated to the right-sided procedure.

• Takeaway: The procedure is entirely unrelated to prior surgery.

Thank you for reaching out to KZA with your inquiry!

*This response is based on the best information available as of 09/17/26.

Modifiers: 58, 78, 79

Question:

Can KZA please explain global modifiers (58, 78, 79)?

Answer:

Excellent question. Modifiers 58, 78, and 79 are used when a patient is in a global period following a prior procedure. Each modifier signals a specific circumstance to the payer, impacting reimbursement and compliance. Here is how they differ:

Modifier 58 - Staged or Related Procedure

• Used when:

  • Planned or anticipated (staged);

  • More extensive than the original procedure; or

  • Therapy is provided following a surgical procedure.

• Key Points:

  • Resets global period.

  • No payment reduction.

• Example: Removal of remaining thyroid tissue for completion thyroidectomy in the global period after a partial thyroidectomy (60260-58).

• Takeaway: The procedure is more extensive, planned, or anticipated.

Modifier 78 - Unplanned Return to the Operating/Procedure Room

• Used when:

  • The patient returns to the OR for an unplanned procedure related to the initial surgery.

• Key Points:

  • No change to the global period.

  • Payment reduction.

• Example: Patient returns to the OR following a tonsillectomy for a tonsillectomy bleed (42962-78 – Control of oropharyngeal hemorrhage; with secondary surgical intervention (typically return to the OR for operative control of bleeding).

• Takeaway: The procedure performed involves an unexpected return to the OR for a related procedure – typically a complication.

Modifier 79 - Unrelated Procedure or Service

• Used when:

  • Unrelated Procedure or Service.

• Key Points:

  • Resets global period.

  • No payment reduction.

• Example: A patient is seen at the first post-op visit 4 days after a tympanoplasty (10 day global) and now complains of hoarseness likely due to the endotracheal tube used for anesthesia. You perform a flexible laryngoscopy (31575-79, you may also want to record 99024 for the post-op visit though it of course has a $0 charge).

• Takeaway: The procedure is entirely unrelated to prior surgery.

Thank you for reaching out to KZA with your inquiry!

*This response is based on the best information available as of 09/10/26.

Microfracture?

Question:

Can microfractures be billed separately with meniscectomies when performed to promote healing? I have not been able to find any clear guidance on this. Thanks!

Answer:

Great question. While there is no CPT guidance specific to meniscectomies, CPT does address a related concept in the context of notchplasty performed to enhance the healing response for meniscal repairs. In that situation, CPT indicates that the notchplasty is considered part of the meniscal repair procedure and is not separately reportable.

Applying this same principle, a microfracture procedure performed solely to promote healing following a meniscectomy would likewise be considered inclusive to the primary procedure.

Thank you for reaching out to KZA!

*This response is based on the best information available as of 09/10/26.

Closure Following Mohs Surgery

Question:

If a patient is referred to a plastic surgeon after a Mohs surgeon performs a Mohs procedure, to perform a complex repair, do I need to add a modifier to the plastic surgeon's repair code?

Answer:

Thank you for your question. You do not need a modifier on the plastic surgeon’s repair code when the Mohs surgeon and the repairing surgeon are different specialties.

When two different physicians perform services on the same day, Medicare and most commercial payers treat them as separate providers, each with their own global surgical package. Because of that:

• The Mohs surgeon bills the Mohs codes (17311–17315).

• The plastic surgeon bills the appropriate repair code (simple, intermediate, complex, flap, graft, etc.).

• No modifier (e.g., -58, -59, -79) is required because there is no global period conflict between two different physicians.

This is consistent with standard Mohs billing guidance, which states that repairs performed by a different provider are billed normally and not considered part of the Mohs surgeon’s global package.

*This response is based on the best information available as of 09/03/26.